What are the treatments for non-Hodgkin lymphoma?
The specialists at Humanitas have extensive experience in the treatment of NHL with the most advanced methods of chemotherapy, biological therapy, radiation therapy and transplantation of peripheral blood stem cells or bone marrow cells, as well as innovative treatments such as biological therapy and radioimmunotherapy.
The choice of therapy depends on the type and stage of the disease, the patient's age and overall health. Humanitas the national reference centre for research on lymphomas and a leader in developing new therapies for non-Hodgkin lymphoma. There have been conducted numerous clinical research protocols that may be appropriate for patients who do not respond to standard treatments.
Early-stage of the disease (I-II)
The patient suffering from indolent lymphoma in the initial stage (localized disease from one side of the diaphragm) is generally subjected to radiotherapy with the application of radiation in doses that are suitable to destroy the neoplastic cells. Patients with aggressive lymphoma in early stages are subjected to a short chemotherapy (3 cycles) associated with monoclonal antibody (rituximab) if the disease is derived from B cells, and is then subjected to radiation therapy.
Advanced stage of the disease (III-IV)
The patient with indolent lymphoma in advanced stages does not always require immediate treatment if the disease does not show clinical signs of rapid evolution. The start of the treatment can be postponed while the patient is regularly monitored. Otherwise, the treatment involves 6 to 8 cycles of chemotherapy, always associated with rituximab if the lymphoma is derived from B-lymphocytes. The patient with aggressive lymphoma at an advanced stage is subjected to 6-8 cycles of chemotherapy (always associated with rituximab for lymphoma B) that needs to be administered immediately.
In the choice of chemotherapy a combination of drugs is used, administered by intravenous injection, to destroy cancer cells that grow quickly. Moreover, there are drugs to be taken orally, however, today those medications are reserved for elderly patients with other underlying conditions that carry risks associated with the administration of intravenous therapy.
The aggressive lymphomas can arise even in primitive extranodal organs such as the brain, and in this case require chemotherapy and additional targeted radiotherapy.
Relapse
Standard treatment of recurrent cancer in patients up to 65-70 years of age with a good overall condition involves high-dose chemotherapy with transplantation of autologous stem cells. In case of failure in the first attempt, the transplantation procedure can be performed again with allogeneic stem cells from a brother/sister, a compatible donor or volunteer.
Clinical research protocols
Humanitas is a "Comprehensive Cancer Centre" where one interest is to design and develop clinical research protocols. It is controlled using new therapies that are not yet officially approved. The clinical research protocols are designed to determine the safety and efficacy of a therapy: they may not represent a cure, but may extend life or improve the quality of life.
These protocols may include the use of new molecules from different sources, such as chemotherapy or biological therapy, whose action is targeted to the mechanism of cell proliferation characteristic to a specific type of tumor ("intelligent drugs"). For more information and to understand which protocols may be appropriate for your case, it is recommended that patients talk to their health care provider.
Radioimmunotherapy
These are drugs that combine a monoclonal antibody specific for lymphoma (derived from B lymphocyte) with radioactive isotopes. These compounds bind to the tumour cells, using the antibody that recognizes them, and subsequently destroy them through a radioactive component.
Radioimmunotherapy is generally well tolerated, and side effects are very rare. Therefore, in some cases it has been offered to patients who cannot receive aggressive therapies, provided that they are monitored regularly in in terms of cell count values.
In Italy there is only one type of radioimmunotherapy (ibritumomab tiuxetan: combination of anti-CD20 antibody rituximab with ittrio90), whose administration is approved for relapsed follicular indolent lymphomas or as consolidation after the first line of chemotherapy.
